Interview with IBS Specialist Dr. Stephen Wangen

Editor's Comment: IBS is a comorbid condition that frequently occurs with fibromyalgia and ME/CFS. Recently, Celeste Cooper, RN, shared the trials and tribulations of living with IBS in her article “Coming Clean on a Dirty Secret: Irritable Bowel Syndrome.” Here, she interviews IBS specialist Dr. Stephen Wangen about the causes and treatments for this painful and often embarrassing condition.

Reprinted with the kind permission of Celeste Cooper, RN.

Celeste Cooper's Interview with Dr. Wangen, IBS Specialist

It is the opinion of this interviewer, Celeste Cooper, RN, that irritable bowel syndrome is a comorbid condition to many immune disorders. In my interview with Dr. Wangen, I found what he had to say very interesting, and I think you will too.

Dr. Stephen Wangen, ND and the IBS Treatment Center have a mission to provide the best care possible for irritable bowel syndrome. He says, “You not only look at symptoms, you have to look for the cause of the problem and, most drugs are only designed to treat symptoms.”

So Dr. Wangen:

How do you determine need?

Anyone suffering from a digestive problem needs to seek help from someone who is focused on solving IBS. Digestive problems should not be unpredictable. In fact, they shouldn't happen at all except on rare occasions.

Can you share a few of the causes you have found in IBS?

There are so many causes. One of the advantages of specializing in this area is the ability to sort through those and determine which are relevant for each patient. The digestive tract is a fascinating ecosystem that contains 100 trillion bacteria and a majority of our immune system. The health of this environment plays a role in the development of food intolerances, food allergies, and food sensitivities, all of which must be assessed. It also is impacted by everything we ingest, and it has the potential to be affected by yeast overgrowth (Candida), parasites, and even stress. All of these play a role in leaky gut syndrome, which is another aspect of digestive health. I have seen patients with food allergies that they never even imagined possible, such as to cane sugar, and people with yeast or parasites that had been completely missed. But most patients have several factors negatively affecting their digestion all at the same time. That is why it is often challenging to figure out by yourself.

Why did you decide to start a center based solely on treatment of IBS?

I once suffered from IBS. When I saw doctors, they had no idea why I had my symptoms. They made guesses and nothing helped. I was told that it was stress and labeled it as IBS. That didn't leave me with any more knowledge than when I first started. I already knew that my bowel irritated me. As I began to see patients, I became more focused on finding the cause of digestive problems, and then I became more successful at helping patients. Ironically, it usually isn’t stress that causes the problem, but IBS that causes the stress!

How many patients do you see with IBS?

I've seen around 4,000 IBS patients.

What is your most difficult type of IBS to treat?

There are many different types of IBS, but they all involve one or more of the following symptoms: diarrhea, constipation, abdominal pain, gas, or bloating. I can't say that one is more complicated than the other. The symptoms only tell me that something is wrong.

As a naturopathic doctor, do you use integrative therapies such as, manual therapies, acupuncture, trigger point therapies, meditation, or nutritional changes?

My goal has always been to solve IBS, not adhere to a medical philosophy. All of the things that you mentioned have value, sometimes even prescription medications. However, all of these treatment modalities are a lot more effective when used in the right ways for right person by assessing each patient individually.

At the IBS Treatment Center, we focus on trying to find the cause of the problem. There are many assessment tools including unique labs for testing the environment of the bowel and its effect on the body. They are not all created equal. We test the labs, use different labs in different situations, and we apply various treatments based on what works best for each individual.

Can you tell us a bit more about what you are looking for with lab results?

Lab results help us develop our priorities. A good lab will properly identify the correct food intolerance, for example. And a highly specialized parasite lab will find parasites that other labs miss. However, even lab work has its limitations. Many aspects of what we do have come from years of clinical experience. Sometimes experience and listening to your patient is more valuable than lab work. We combine both to get the best results possible.

What can the patient expect as an active participant in the treatment protocol?

Anyone who thinks that health can be handed to you from someone else is gravely mistaken. Patients often need to make dietary changes, but these are targeted changes based on each patient’s lab results. If patients are willing to participate in their plan, they have a very good chance of getting better.

Do you consider gluten to be an irritant to the bowel and do you feel this is true for ALL IBS patients?

Gluten intolerance is just one of many possible irritants involved in IBS. It may or may not be a factor for an individual. Determination is based on what we find with the patient’s lab results.

An anti-inflammatory diet is suggested for arthritis and autoimmune disorders. What are your thoughts on suggesting it for IBS patients?

Inflammation is produced by the immune system and the immune system must be triggered to turn it on. Different foods will turn on inflammation in different people. A successful anti-inflammatory diet is about identifying the specific triggers in each individual. There is no one size fits all anti-inflammatory diet, but there is an anti-inflammatory diet for each patient.

In general, what is the easiest to overcome and what is the most difficult? (ie. infrequent attacks vs IBS and bowel disease).

Inflammatory bowel disease (IBD), which is very different from IBS, is often the most difficult, but even then we have good success.

You don’t feel patients with IBS and bowel diseases such as Crohn’s disease or diverticulosis have more difficulty controlling incontinence or increased bowel motility?

All of these diagnoses -- IBS, Crohn's disease, and even diverticulosis, include a wide spectrum when it comes to the severity of the symptoms that can be experienced. Even though each diagnosis is different with regard to the underlying damage that has occurred, some people have relatively mild symptoms, and others are in the hospital. This is even true for IBS. Therefore, I don't like to underestimate one person's problems just because they don't have a diagnosis that the medical community considers as serious as another. I try not to judge my patients or predetermine who can get better. Everyone should have hope that they can heal, because they usually can.

How long does it take for your protocol to work?

Every patient has different components that we are treating, so it varies. Healing is like putting together a puzzle. There is usually more than one piece to the puzzle, and every puzzle is different. In general we should be seeing improvement within about a month after implementing treatment and continuing over the next several weeks. Some patients heal quickly, and others take longer, but the goal is to get them moving in the right direction and then keep them on that path.

I understand that treatment is individualized, but what are your general thoughts on probiotics?

The good bacteria in your digestive ecosystem are critical to digestive health. But not everyone needs probiotics, and probiotics are certainly not all created equal. I like to assess the bacterial environment before I even recommend probiotics, because there are some people who feel worse when they take probiotics and others who are just wasting money taking them. However, when I do recommend probiotics I usually use a full spectrum probiotic that contains as many different species as possible.

What can the patients, who are proactive in their role, hope to achieve?

Patients should expect a significant improvement in their health. I think that people often let the medical system off the hook too easily. If you take your car into the mechanic and they tell you that they can't fix it, then you find someone who can. Our goal is to help people get better. Sometimes the most difficult aspect is getting the patient to believe that improvement is possible. If every other highly respected expert is telling you that there is nothing that you can do, then you start to believe it. Unfortunately we're not perfect, but we have a great deal more to offer than most people are getting elsewhere. It's what makes my job so rewarding!

It was a pleasure to do this interview with Dr. Wangen and inspiring to know there are doctors who treat IBS patients comprehensively. Naturopathic doctors are not all created equal, and this one had me at “our goal is to improve patient outcome, based on the individual patient.” There is no cookie cutter answer to managing IBS, and it is refreshing to speak with a healthcare provider that understands how IBS affects a patient’s quality of life, then sets about improving it.